Warm Handoff or Cold Bodies?

In April, Florida Gov. Ron DeSantis announced $26 million in additional federal funding for Florida’s State Opioid Response Project. The project aims to reduce opioid deaths, prevent opioid abuse among youth, and increase recovery services and access to treatment.

That last part needs to be a top priority of the project. Recovery services and access to quality care—specifically, equitable access to care—needs to become a hallmark of every comprehensive opioid response program, so that those who have overdosed don’t experience a revolving door from ambulance to emergency room and back to the street. America has the best substance abuse treatment in the world, but it is strongly correlated to socioeconomic status. Doctors, judges, lawyers, pilots, nurses, and numerous other professionals all have access to resources that allow for treatment plus continuing follow-up care to prevent relapse. But when it comes to those with less money or fewer professional resources, our system defaults to bury people in prison, or directly in the ground.

If we want to see systemic change, we need our hospitals’ leadership to empower our medical professionals with “warm handoff” programs. We achieved this before in mental health, and we can do it again with substance use disorders. If a patient shows up with self-inflicted cuts, he or she will go from the ER to a follow-up system that includes 72 hours of safe, supportive services, a lethality assessment with medical professionals, and referral to appropriate care.

The American Medical Association has classified substance use disorder as a disease for over half a century. And yet somehow, even with tens of thousands of cases over the last decade of overdose victims being expeditiously discharged from emergency rooms, only to often turn up dead a short while later, we still don’t classify medically dying and being resurrected with lifesaving medication, like naloxone, as “self-harm.” Until we classify killing oneself via overdose, even with reversal, as self-harm, we’re going to see our death toll, already at more than 70,000 Americans per year, continue to rise.

Probably the single most important step towards saving lives on the front lines is seeding hospital systems’ boards of directors and trustees with individuals who have a comprehensive knowledge of substance use disorders and mental health concerns. Boards with this knowledge can advocate for systemic protocols that allow for effective warm handoff to treatment.

The EMS first responders know the current system is broken. So do the doctors, nurses, and the families who end up burying those same patients. Hospital systems are a critical stakeholder in addressing the leading cause of death for Americans under age 55. It’s unconscionable that we haven’t addressed this glaring systemic deficiency in a meaningful way by 2019.